Overview

Occipital neuralgia is a type of headache caused by injured or inflamed occipital nerves. Those living with this condition often experience severe piercing, throbbing, or shock-like pain in their upper neck, back of their head, or behind their ears. Occipital neuralgia can be either a primary or secondary medical condition but is not a life-threatening condition. 

Researchers continue to study this condition, as the lived experience of this condition and its treatment outcomes vary significantly between patients.

Treatment options 

• Rest 
• Heat therapy
• Physical or massage therapy
• Routine exercise, stretches, yoga
• Medication: over-the-counter pain relievers, anti-inflammatory medications, prescription muscle relaxants, and anticonvulsants
• Percutaneous nerve blocks 
• Botox Injections to reduce inflammation in the affected nerve
• Surgical options:
  • Occipital Nerve Stimulation: in this procedure, your medical professional implants a small device at the base of your skull that sends electrical impulses to the occipital nerve to reduce the frequency of headaches or migraines. 
  • Spinal Cord Stimulation: This procedure is similar to occipital nerve stimulation, but your medical professional will implant the electrodes of the stimulator in your epidural space and the power source near your buttocks or abdomen. Spinal cord stimulation treats or manages different types of chronic pain, while occipital nerve stimulation only treats or manages head pain. 
  • C2,3 Ganglionectomy: During this procedure, your medical professional removes the second or third cervical sensory dorsal root ganglion to reduce pain caused by occipital neuralgia. 

Symptoms

Common symptoms of occipital neuralgia include continuous aching, burning, and throbbing pain coupled with intermittent shocking or shooting pain at the base of the head. The pain may travel up the scalp on one or both sides of the head. Those living with occipital neuralgia may experience pain behind the eyes. Some living with occipital neuralgia may experience tenderness on their scalp and photosensitivity. 

Diagnostic tests

Before visiting your doctor, track the frequency, severity, and duration of any symptoms of occipital neuralgia. If you experience pain in your neck or occipital lobe, document if you experience any other common migraine symptoms, such as nausea or sensitivity to light and sound. This can help your doctor determine if your symptoms are caused by a migraine or by occipital neuralgia. Document any injuries or trauma to the neck, as these can cause symptoms similar to those associated with occipital neuralgia. 

During the examination, your doctor will perform a physical exam and order several diagnostic tests to rule out other possible causes of your head and neck pain. There is no one test to diagnose occipital neuralgia, but an occipital nerve block can help diagnose and temporarily treat it. You may need an X-ray, MRI, or CT scan to rule out any underlying pathologies, such as muscular disorders or injuries and arthritis. 

Causes

Many causes of head pain are attributed to chronic neck tension or pinched nerves in the neck, but the cause of occipital neuralgia is not always known. 

Potential causes include:

• Blood vessel inflammation
• Cervical disc disease
• Diabetes
• Gout
• Head or neck injury
• Infection
• Osteoarthritis of the upper cervical spine
• Trauma to occipital nerves

Facts 

True isolated occipital neuralgia is quite rare and is often diagnosed as migraines.